This monograph is a stimulating reading of the Book of Margery Kempe within the context of medieval discourses about medicine and the female body. Laura Kalas approaches Kempe's Book from the perspective of the medical humanities, presenting original interpretations that highlight Kempe's authority and agency. Rather than anachronistically diagnosing Kempe with a modern mental or physical illness, as many have before, Kalas argues that Kempe and her contemporaries used medieval medical theories and practices to understand her mystical suffering. Kempe's salvific pain was rooted in her female, humorally melancholic body, which qualified her to act as a physical surrogate for Mary and Christ in different ways throughout her life cycle.

Chapter 1 provides a template for the remaining chapters, using medical concepts and terminology—there is a helpful glossary at the end of the book—to interpret resemblances between the Book and medical writings ranging from Hippocrates to a 1621 encyclopedia. By analyzing Kempe's behavior and contemporary reactions, Kalas argues that Kempe's humors were imbalanced in favor of black bile, predisposing her to both madness and mystical experiences. Her painful tears were a symptom of and a treatment for her condition.

Chapters 2 to 4 and chapter 6 follow Kempe's life course, although Kalas recognizes the challenges of this approach given the Book's achronological presentation of events. Chapter 2 focuses on the beginning of Kempe's visions, when she suffered a period of postpartum illness, eventually cured by Christ. Kalas insightfully reveals the paradox of female sexuality in the Middle Ages: medical treatises viewed both marital sex and celibacy as physically painful and dangerous for women. With God's help, Kempe enacted protective measures that mitigated her feminine suffering and made it spiritually productive.

Chapters 3, 4, and 6 focus on the post-reproductive Kempe, now in a chaste marriage with Christ and, Kalas argues, undergoing menopause. As the author acknowledges, menopause was not seen as a distinct part of the female life cycle in the Middle Ages, and so her conclusions about medieval interpretations and experiences of menopause in these chapters are suggestive but somewhat tenuous. Chapter 3 depicts Kempe's tears as a substitute for her absent menses, rebalancing her humors and allowing her to serve as a surrogate mother for both Christ and earthly children. In chapter 4, Kalas explores instances when Kempe imitated Christ's role as a healer. She treated temporarily insane and leprous women, as well as her son and husband, by compassionately taking on their pain and making it spiritually meritorious through “pain surrogacy” (129). Chapter 5 departs from the chronological narrative in order to make a more programmatic point: that Margery's melancholic body facilitated her “death surrogacy” for Christ, sympathetically experiencing his passion and preparing for her own death (161). Kempe's life cycle concludes in chapter 6 with an analysis of book 2, which Kalas intriguingly argues is a more immediate representation of the mystic's personality than book 1 because it recounts events chronologically closer to the Book's dictation. The increased wisdom and bodily suffering of old age enabled Kempe to claim spiritual authority more fully, while writing her Book allowed her to achieve postmenopausal reproduction.

The density of the prose makes this book a challenge, but it rewards careful attention, as the consonances between aspects of medical thought and Kempe's experiences are striking. It is not clear, however, how accessible the medical texts Kalas analyses would have been for an illiterate laywoman in late medieval England. Further research into English book culture could have helped answer this question concretely. Indeed, the book relies heavily on pan-European studies of medieval thought. Although Kalas is certainly correct that Kempe's spirituality was influenced by European models, much of her life was spent in England, and incorporating more of the existing research on bourgeois life, childbirth, childhood, marriage, medical care, and religious practice in medieval England into this study would have helped ground the analysis in Kempe's historical context. Nevertheless, this book is a thought-provoking contribution to the literature on Kempe and will appeal to specialists with a focus on medieval mysticism, sex and gender, and medicine.